Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity

Background In chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral. The Kidney Disease: Improving Global Outcomes clinical practice guidelines for CKD recommend...

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Published in:BMC family practice Vol. 23; no. 1; pp. 299 - 7
Main Authors: Chu, Chi D., Powe, Neil R., Shlipak, Michael G., Scherzer, Rebecca, Tummalapalli, Sri Lekha, Estrella, Michelle M., Tuot, Delphine S.
Format: Journal Article
Language:English
Published: London BioMed Central 24.11.2022
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Adult
Aged
Albuminuria
Albuminuria - diagnosis
Cardiovascular disease
Chronic kidney disease
Chronic kidney failure
Clinical medicine
Clinical practice guidelines
Complications and side effects
Creatinine
Diabetes
Diagnosis
Family Medicine
General Practice
Glomerular Filtration Rate
Health care access
Hemodialysis
Humans
Hypertension
Kidney diseases
Laboratories
Medical care
Medical referrals
Medicare
Medicine
Medicine & Public Health
Nephrology
Nephrology referral
Primary care
Primary Care Medicine
Renal Insufficiency, Chronic - diagnosis
Research Article
Risk factors
United States - epidemiology
Utilization
United States
United States > US
Chronic kidney disease
Nephrology referral
Albuminuria
ISSN:2731-4553, 2731-4553, 1471-2296
Online Access:Get full text
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Summary:Background In chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral. The Kidney Disease: Improving Global Outcomes clinical practice guidelines for CKD recommend nephrology referral for eGFR < 30 ml/min/1.73m 2 or for urinary albumin/creatinine ratio ≥ 300 mg/g. Methods Using a national claims database of US patients covered by commercial insurance or Medicare Advantage, we identified patients with CKD who were actively followed in primary care. We examined receipt of nephrology care within 1 year among these patients according to their stage of CKD, classified using eGFR and albuminuria categories. Multivariable logistic regression was used to examine odds of receiving nephrology care by CKD category, adjusting for age, sex, race/ethnicity, diabetes, heart failure, and coronary artery disease. Results Among 291,155 patients with CKD, 55% who met guideline-recommended referral criteria had seen a nephrologist. Receipt of guideline-recommended nephrology care was higher among those with eGFR < 30 (64%; 11,330/17738) compared with UACR ≥300 mg/g (51%; 8789/17290). 59% did not have albuminuria testing. Those patients without albuminuria testing had substantially lower adjusted odds of recommended nephrology care (aOR 0.47 [0.43, 0.52] for eGFR < 30 ml/min/1.73m 2 ). Similar patterns were observed in analyses stratified by diabetes status. Conclusions Only half of patients meeting laboratory criteria for nephrology referral were seen by a nephrologist. Underutilization of albuminuria testing may be a barrier to identifying primary care patients at elevated kidney failure risk who may warrant nephrology referral.
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ISSN:2731-4553
2731-4553
1471-2296
DOI:10.1186/s12875-022-01910-9